Depigmentation TreatmentThe primary goal of Vitiligo / Leucoderma
therapy is to repigment the affected skin. However, it is not
always possible. All the treatment modalities available for repigmentation
may fail to achieve it. In this situation, depigmentation therapy
can be considered.

Guidelines for Depigmentation Therapy:
1. Unresponsive to therapy or unwilling to treat. Desire for permanent
depigmentation in a patient with Vitiligo / Leucoderma.
2. More than 50% body surface area affected by disease. After
proper evaluation, patients with 30% to 50% involvement can also
be considered for depigmentation treatment.
3. Willingness to accept that repigmentation is no longer possible.

How Does Depigmentation Benefit Vitiligo
Patients?
Vitiligo does not cause any physical disability. Patients are
disturbed because of cosmetic disfigurement and uneven skin color.
Depigmentation removes all brown colouring and makes skin uniformly
white. It is impossible for others to know that this white colour
is due to Vitiligo. For the patient, there is no longer evidence
of cosmetic disfigurement and so the social stigma associated
with Vitiligo / Leucoderma is removed.

What method is used to acheive Depigmentation?
Mononbenzyl ether of hydroquinone (MBEH) or monobenzone is the
key to depigmentation. Local application of a cream containing
MBEH leads to loss of melanin pigment of skin. There is no injection
or oral medicine which can lead to depigmentation.

Procedure
The patient applies MBEH 20% cream, once a day to a small patch
of one arm for a week. This is to test for sensitivity.. Thereafter,
it is applied two times a day to one or both arms and face, mainly
the exposed parts. Patients will experience a gradual process
of depigmentation. Skin slowly lightens and ultimately becomes
white. Once the exposed parts are depigmented, patients can use
the cream on other parts of the body.

The entire process can take 1 to 2 years to achieve complete depigmentation.
In some patients it may be longer, up to 4 years. We do not advise
application of cream to entire body at one time. This is because
application of this cream at one site usually leads to loss of
pigment at distant sites, eg application of MBEH to the arm may
lead to depigmentation of the chest or abdomen.

Will the color of hair and eyes change?No. The cream does not affect melanocytes
of eyes and hair roots. Color of hair and eyes will not change.

Further
InformationWhat are the adverse effects?
The most common side effect is irritant reaction to the cream. A
stinging feeling may occur immediately after the cream application
and will last for a few minutes. If one is allergic, a rash will
appear within 1 to 4 days of application.

In this situation, medicine is discontinued and restarted after
the rash subsides. A lower concentration (e.g.5%) is used and gradually
increased to 20%. Allergy occurs in the normal pigmented skin, and
not in the white patches.

Allergic reactions are very rare and we have not experienced discontinuation
of treatment because of allergy.

What are the precautions?Avoid application to the eyelids and
areas close to the eye.
Avoid application at bedtime as the cream inadvertently may go into
the eyes and skin-to-skin contact with a spouse will cause decrease
in pigmentation at the site of contact on the spouse.
Daily use of sunscreen is essential all year round.

Information for patients considering depigmentation

Usually most patients will respond and depigment. The result is
a uniform white skin colour. We never had any patient who was
unhappy after being depigmented.

If a patient does not respond satisfactorily, we can increase
the concentration to 30% or 40%.

Sometimes, brown-pigmented spots on face or other sun exposed
areas may appear in summer. These are treated with an application
of higher concentration of MBEH cream.

For patients with widespread and resistant Vitiligo / Leucoderma,
depigmentation therapy is a viable treatment option. For most
patients loss of pigment is permanent. If anyone is ambivalent
because of hope of future more successful therapies for Vitiligo
/ Leucoderma, they should not undergo depigmentation therapy.